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Tiffany Roy FNP LLC

Organization Active NPI Rural Health Clinic/Center · Duson, LA

NPI 1376986257 · NPPES record last updated Jul 25, 2022

Key facts

NPI
1376986257
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
TIFFANY ROY FNP LLC
Practice address
110 W. First St
Suite a
Duson, LA 70529
Phone
(337) 873-8244
Fax
(337) 873-8274
NPI assigned
Apr 10, 2013
Organization subpart
No

Authorized official

Name
Tiffany S Roy, FNP
Title
Owner/Sole Member
Phone
(337) 873-8244

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Tiffany Smith Roy, N.P. Family Nurse Practitioner · Duson, LA · NPI 1568645430
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · CORPORATE OFFICER

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA

Rural health clinic certification: CCN 193908

Legal name
TIFFANY ROY FNP LLC
Doing business as
DUSON FAMILY HEALTHCARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 13, 2014
Last certification
Sep 27, 2023
Ownership / control type
1B
Organization structure
LLC · Proprietary
Incorporated
Jul 28, 2008 in LA
Enrollment address
110 W First St
Suite a
Duson, LA 70529

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cynthia Smith
Individual 		W-2 Managing Employee
Billing Manager		 Apr 25, 2013 10%
Tiffany S Roy
Individual 		5% Or Greater Direct Ownership Interest Sep 19, 2008
Corporate Officer
Sole Member		 Apr 25, 2013 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080919000275 LA Part B Supplier - Clinic/Group Practice 9739256512 Receives reassigned benefits from 33 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Duson, LA
O20130614000128 LA Part a Provider - Rural Health Clinic 9739256512 Practice locations: Duson, LA

National Provider Directory

Tax ID family
Duson Family Healthcare (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

110 W. First St
Suite a
Duson, LA 70529

Mailing address

PO Box 370
Duson, LA 70529-0370
Phone (337) 873-8244

Other names

  • Duson Family Healthcare Doing business as

Other providers in Duson, LA

All providers in Duson, LA · Rural Health Clinic/Center in Louisiana

Sources for this page

Verify at the official NPI Registry.